V1 - Robotic Assisted Recurrent Perineal Hernia Repair

Purpose/Background: Perineal hernias following abdominoperineal resection can be associated with significant symptoms for the patient. Both transperineal and transabdominal repairs are described. Transabdominal repairs are performed via either minimally invasive or open approach. Robotic transabdominal repair has been recently gaining popularity as a viable option for repair.

Methods/Interventions: Multiple patients at our institution with perineal hernias have been treated utilizing both transperineal and transabdominal approaches. We present a video describing the transabdominal procedure following failure of the transperineal approach.

Results/Outcomes: The case is a 50-year-old male with a T3N2 distal rectal cancer involving the levator ani muscle. The patient underwent long course chemoradiation followed by consolidation chemotherapy. He had residual local disease on repeat staging and underwent robotic assisted abdominoperineal resection. The patient developed a symptomatic perineal hernia and underwent a transperineal hernia repair with mesh placement. Unfortunately, the hernia recurred 6 months later, and the patient underwent a second transperineal hernia repair. A second recurrence of the hernia occurred and the patient was taken for planned transabdominal repair. Robotic assisted perineal hernia repair with mesh was performed utilizing the bladder as a scaffold for the mesh. At his 1 year follow up, there is no evidence of hernia recurrence.

Conclusion/Discussion: Robotic assisted transabdominal hernia repair with mesh is feasible. Knowledge of both transperineal and transabdominal approaches will allow the surgeon to individualize the surgical approach to each patient. Robotic assisted repair is also a reasonable approach to repair recurrent perineal hernias.